title: Impact of cigarette smoking on utilization of nursing home services.
abstract: BACKGROUND
  Few studies have examined the effects of smoking on nursing home utilization, generally using poor data on smoking status. No previous study has distinguished utilization for recent from long-term quitters.
  
  
  METHODS
  Using the Health and Retirement Study, we assessed nursing home utilization by never-smokers, long-term quitters (quit >3 years), recent quitters (quit ≤3 years), and current smokers. We used logistic regression to evaluate the likelihood of a nursing home admission. For those with an admission, we used negative binomial regression on the number of nursing home nights. Finally, we employed zero-inflated negative binomial regression to estimate nights for the full sample.
  
  
  RESULTS
  Controlling for other variables, compared with never-smokers, long-term quitters have an odds ratio (OR) for nursing home admission of 1.18 (95% CI: 1.07-1.2), current smokers 1.39 (1.23-1.57), and recent quitters 1.55 (1.29-1.87). The probability of admission rises rapidly with age and is lower for African Americans and Hispanics, more affluent respondents, respondents with a spouse present in the home, and respondents with a living child. Given admission, smoking status is not associated with length of stay (LOS). LOS is longer for older respondents and women and shorter for more affluent respondents and those with spouses present.
  
  
  CONCLUSIONS
  Compared with otherwise identical never-smokers, former and current smokers have a significantly increased risk of nursing home admission. That recent quitters are at greatest risk of admission is consistent with evidence that many stop smoking because they are sick, often due to smoking.
authors.affiliation: Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI;
authors.forename: Kenneth E
authors.initials: KE
authors.lastname: Warner
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: McCammon
authors.forename: Brant E
authors.initials: BE
authors.lastname: Fries
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Langa
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes / Q000706:statistics & numerical data*; D012306:Risk; D057566:Self Report; D012907:Smoking / Q000009:adverse effects*; D012959:Socioeconomic Factors; D014481:United States; D044465:White People / Q000706:statistics & numerical data*